Process evaluation of a community-based program for prevention and control of non-communicable disease in a developing country: The Isfahan Healthy Heart Program, Iran

<p>Abstract</p> <p>Background</p> <p>Cardiovascular diseases are the most common cause of mortality in Iran. A six-year, comprehensive, integrated community-based demonstration study entitled Isfahan Healthy Heart Program (IHHP) conducted in Iran, and it started in 2000. Evaluation and monitoring are integrated parts of this quasi-experimental trial, and consists of process, as well as short and long-term impact evaluations. This paper presents the design of the "process evaluation" for IHHP, and the results pertaining to some interventional strategies that were implemented in workplaces</p> <p>Methods</p> <p>The process evaluation addresses the internal validity of IHHP by ascertaining the degree to which the program was implemented as intended. The IHHP process evaluation is a triangulated study conducted for all interventions at their respective venues. All interventional activities are monitored to determine why and how some are successful and sustainable, to identify mechanisms as well as barriers and facilitators of implementation.</p> <p>Results</p> <p>The results suggest that factory workers and managers are satisfied with the interventions. In the current study, success was mainly shaped by the organizational readiness and timing of the implementation. Integrating most of activities of the project to the existing ongoing activities of public health officers in worksites is suggested to be the most effective means of implementation of the health promoting activities in workplaces.</p> <p>Conclusion</p> <p>The results of our experience may help other developing countries to plan for similar interventions.</p

OBESITY AND ITS ASSOCIATION WITH OTHER CARDIOVASCULAR RISK FACTORS IN WOMEN IN CENTRAL IRAN - WOMEN'S HEALTHY HEART PROJECT

Abstract&nbsp; INTRODUCTION: Cardiovascular diseases (CVD) are considered the most important cause of death worldwide. Obesity is a major CVD risk factor. This study was conducted to evaluate the prevalence of obesity and its association with other CVD risk factors in Iranian women. methods: This cross-sectional study was conducted in 2001 as part of Isfahan Healthy Heart Program (IHHP) in three Central Iranian cities of Isfahan, Najaf-Abad and Arak. Being over 19 years of age, absence of pregnancy, absence of mental retardation and Iranian nationality were the criteria for inclusion in the study. A questionnaire on demographics characteristics, drug consumption, smoking status, and physical activity were filled out for every subject. Height, weight and blood pressure of all subjects were measured and fasting blood samples were taken to measure blood glucose and lipids. The data were analyzed with T-test, &chi;2 and multiple linear regression, using SPSS11. results: Of 6391 women aged 38.8&plusmn;14.5 years participating in the study, 79% lived in the urban areas and 21% in the rural areas. The prevalence of a higher BMI was greater in urban areas in all ages. Hypertension, diabetes, total cholesterol-triglyceride and LDL-C disorders and inadequate physical activity were more prevalent in obese women than normal ones, but no significant difference was seen in HDL-C disorder and smoking between the two groups (P&lt;0.05). There was a significant positive relationship between BMI and age, blood glucose and urban residence, and a negative relationship was observed between BMI and inadequate physical activity (P&lt;0.05). Discussion: The high prevalence of obesity and the major risk factors of cardiovascular diseases in urban areas is testament to unhealthy lifestyle and insufficient physical activity of women in areas studied.Keywords . Women . Obesity . Residence . Risk factor</p

The relation between breakfast consumption and psychological symptoms among adults

Background: Breakfast skipping was related to obesity and obesity has been associated with psychological disorders, but limited data are available linking breakfast consumption to psychological symptoms. Objective: The association between breakfast consumption and psychological disorders, including depression and anxiety, was studied among Iranian adults. Methods: This cross-sectional study was conducted on 4378 healthy adults in Isfahan, Iran. Breakfast consumption was assessed using a validated detailed dietary habits’ questionnaire; and depression and anxiety using an Iranian validated Hospital Anxiety and Depression Scale (HADS) questionnaire. Psychological distress was also examined by means of Iranian validated version of General Health Questionnaire. Findings: Overall, 611 numbers (13.95%) of study participants had anxiety, 1253 numbers (28.62%) depression, and 1015 numbers (23.18%) probable mental disorders symptoms. After controlling for the confounding variables, participants with every day breakfast consumption had lower odds for depression symptoms (OR: 0.49; 95% CI: 0.36-0.66) compared with those with the least frequent intake of breakfast, even after further adjustment for BMI (OR: 0.47; 95% CI: 0.34- 0.63). Frequent breakfast consumption was inversely associated with anxiety before and after controlling for BMI (P<0.001). The same findings were obtained for probable mental disorders (P<0.001). Conclusion: This study showed an inverse relation between breakfast consumption and symptoms of depression, anxiety, and probable mental disorders among Iranian adults. Further prospective studies are needed to confirm these findings

Association between healthy lifestyle score and upper gastrointestinal disorders in Iranian adults

Background and Objective: Although lifestyle-related factors have separately been examined in relation to functional gastrointestinal disorders (FGIDs), there is no epidemiologic data on the combined association of lifestyle factors with these conditions. We aimed to examine how combinations of several lifestyle factors were associated with functional dyspepsia (FD), its symptoms and gastro-esophageal reflux disease (GERD) in a large group of Iranian adults. Methods: This descriptive -analytic study was conducted on 3363 Iranian adults (19-70 yr), whom were working in 50 health centers across Isfahan province in Iran during 2012. We used easy non-random sampling to select participants. The “healthy lifestyle score” for each participant was calculated by summing up the binary score given for five lifestyle factors, including dietary habits, dietary intakes, psychological distress, smoking and physical activity. A dish-based 106-item semi-quantitative validated food frequency questionnaire, General Practice Physical Activity Questionnaire, General Health Questionnaire and other pre-tested questionnaires were used to assess the components of healthy lifestyle score. A validated Persian version of ROME III questionnaire was used, to assess functional gastrointestinal disorders. Results: The prevalence of FD and GERD among study participants was 14.5 and 23.6%, respectively. After adjustment for potential confounders, we found that individuals with the highest score of healthy lifestyle had 79 and 74% lower odds of FD (95% CI: 0.05-0.92, OR: 0.21, P=0.03) and GERD (95% CI: 0.09-0.69, OR: 0.26, P=0.01), respectively, compared with those with the lowest score. They were also less likely to have early satiation (95% CI: 0.11-0.73, OR: 0.28, P=0.001), postprandial fullness (95% CI: 0.09-0.50, OR: 0.22, P<0.001) and epigastric pain (95% CI: 0.21-0.92, OR: 0.44, P=0.03). In addition to the combined healthy lifestyle score, low levels of psychological distress, a healthy diet, healthy dietary habits and non-smoking were separately associated with FGIDs (P<0.05). Conclusion: This study showed that adherence to a healthy lifestyle was associated with lower odds of GERD, FD and its symptoms in this group of Iranian adults. Individual lifestyle-related factors were also associated with these conditions